Psychodynamic Psychotherapy Research Articles

Internet-Delivered Affect-Focused Psychodynamic Therapy for Adolescent Depression: Treatment Principles and Clinical Application in the ERiCA Project

ABSTRACT Internet-delivered, therapist-guided, self-help programs are novel ways to deliver psychotherapeutic interventions adapted from established therapy models. Such programs can be easily accessed online and may offer an important treatment option for patients who struggle with barriers to seeking out and engaging in face-to-face psychotherapy, including depressed adolescents. While there are evidence-based Internet-delivered self-help programs based on cognitive-behavioral therapies (i.e. ICBT) for adolescent depression, a program based on psychodynamic principles (i.e. IPDT) has so far been lacking. In this article we describe the IPDT program developed within the ERiCA project, which has so far been evaluated in two randomized controlled trials (RCTs). We further provide a case example from one of the trials to illustrate the treatment process and therapeutic interaction in detail. Given the novelty of the approach, we will particularly highlight and discuss how a psychodynamic understanding of adolescent development and depressive dynamics as well as affect-focused treatment principles inform the treatment, including the therapist’s role, tasks, and choice of interventions. The potential implications and utility of IPDT for regular clinical practice are elaborated as well as potential research directions for the future.

Evaluating the 20-day Dynamic Interpersonal Therapy (DIT) training programme: a mixed methods investigation to identify characteristics associated with successful outcomes of DIT

Dynamic Interpersonal Therapy (DIT) is a brief psychodynamic therapy for depression, developed from the fundamental competences of evidence-based psychoanalytic/dynamic therapeutic methods. The 20-Day DIT training programme at the Anna Freud Centre in London is offered for clinicians who do not meet these psychoanalytic/dynamic competences. 28 therapists, each with three patients, underwent the 20-Day DIT training in 2019. The current study evaluated the 20-Day DIT training by investigating factors associated with the successful patient outcomes of this cohort. Reliable recovery and reliable improvement of patients was 69% and 90%, respectively. Quantitative analyses found that patients who have positive outcomes were likely to have lower baseline Patient Health Questionnaire-9 (PHQ-9) scores and lower patient complexity. A thematic analysis of the therapists’ perspectives suggested that the most important elements of DIT perceived to be associated with successful patient outcomes cluster around four superordinate themes: aspects of the DIT model/training, characteristics of the patient, aspects of the patient-therapist relationship, and characteristics of the therapist. The results suggest that the DIT protocol can be acquired by novice therapists in psychoanalytic/dynamic methods and offer insight into the factors that may be associated with successful outcomes.

Case Analysis of a Patient with Functional Pathological Crying

IntroductionFunctional pathological crying is a complex psychic phenomenon which poses both diagnostic and management challenges to the psychiatrist and psychotherapist. Apart from treatment with medications when clinically indicated, psychodynamic psychotherapy can be useful to understand the aetiology and to address these psychological issues faced by patients.ObjectivesIn this case report, psychodynamic psychotherapeutic techniques are employed to examine and manage functional pathological crying.Ms L was a 33-year-old Chinese single woman who presented with mixed depressive and anxiety symptoms associated with frequent severe bouts of wailing. She had a history of parental neglect and childhood sexual abuse. Following psychiatric assessment, she was diagnosed with Mixed Depressive and Anxiety Disorder, and Borderline Personality Disorder. She was treated with Sertraline 50mg every morning and was referred for psychodynamic therapy.MethodsBuilding trust and rapport with Ms L was crucial so that the therapeutic relationship could be utilized as a vehicle for change through earned attachments. Helping her appreciate how present experiences reflect conflicts from her past and addressing her defence mechanisms with the aims of expression of emotions, exploring her wishes and fantasies to access unconscious conflicts were important. These build greater self-awareness which helped her to develop the capacity for emotional self-regulation, bringing about an increase in her level of adaptation to stressors.ResultsDuring the early phase of therapy, Ms L would be wailing throughout most of the therapy hour. As therapeutic rapport and trust were established, she began to open up about her abuse for us to explore her conflicts and complex emotions associated with it.The key themes that emerged were her chronic low self-esteem with fears of authorities and abandonment, the tendency to take up a defended regressive helpless child-like position whenever feelings related to the abuse were rekindled, as well as the manifestation of these complicated psychic experiences in the form of a complex wailing phenomenon.The functional pathological crying was a mixture of an expression of her challenging conflictual painful feelings, symbolic expression of her cry for help, repressive and regressive child-like emotional states as well as having a defensive function to avoid coming in touch with painful feelings.Through therapy, Ms L was able to make better sense of her wailing, develop the capacity for emotional self-regulation by adopting a healthier adult position in responding to difficult feelings when triggered, learning to forgive herself and others, assume better self-care and improved relationships with others.ConclusionsThrough psychodynamic psychotherapy, complex functional pathological crying can be better understood and managed to bring about intra-psychic and interpersonal functional improvements.Disclosure of InterestNone Declared

Disconnecting from my heartbeat: About a case of derealization in a critically ill patient

IntroductionDepersonalization/derealization encompasses a series of symptoms that are difficult to describe by the patient, as well as complex to diagnose by the professional, and can go through multiple diagnoses prior to the diagnosis of certainty.ObjectivesIt is proposed, through a clinical case, to know the characteristics of this disorder, evolution, differential diagnosis and therapeutic possibilitiesMethods62-year-old male, history of harmful alcohol consumption and a previous admission to a psychiatric short hospitalization unit for self-injury (superficial cuts in the context of severe mental illness of his wife) post-transplantation who is required by ideas of death, anhedonia and lack of collaboration in patient, The day before the evaluation, refusal to take oral treatment, selective mutism. Pre-transplant evaluation where no psychopathological alteration was observed.ResultsWhat is initially assessed and treated as a confusional episode of inactive type, through a correct psychopathological examination and with subsequent continuous interviews, with mood fluctuations throughout the admission, is subsequently oriented as an acute stress disorder, adaptive reaction with an anxious-depressive component and finally concluding that we are facing a dissociative disorder, highlighting the depersonalization/derealization on a dysfunctional personality base.ConclusionsCharacteristic of depersonalization is the great difficulty in describing symptoms, the feeling of being disconnected from one’s own body, emotions and reality. The latest studies on etiopathogenesis with MRI show an inhibitory response on the limbic system by hyperactivation of the ventrolateral prefrontal cortex as well as a decrease in the autonomic response, the initial result being the attenuation of the processing of emotions. Among the differential diagnoses: post-anxiety illness disorder, major depressive episode, other dissociative disorders, panic disorder, psychotic disorder, substance-induced disorder There are several partially effective treatments, although the results so far are poor. SSRIs, quetiapine and naltrexone have been tried. Partial efficacy with lamotrigine together with SSRIs and, if high levels of anxiety coexist, SSRIs together with clonazepam. There are studies where psychodynamic psychotherapy, behavioral therapy and hypnosis have obtained partially effective results.Disclosure of InterestNone Declared

Psychotherapies for generalized anxiety disorder in adults: systematic review and network meta-analysis of randomized-controlled trials

IntroductionGeneralized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatment choices for GAD, but which should be considered as first-line treatment still needs to be clarified.ObjectivesTo examine the most effective and accepted psychotherapy for GAD both in the short and long-term, via a network meta-analysis.MethodsWe searched MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials – CENTRAL, from database inception to January 1st, 2023, to find randomized controlled trials (RCTs) of psychotherapies for GAD. Eight psychotherapies (behaviour therapy, cognitive-behaviour therapy, cognitive restructuring, psychoeducation, psychodynamic therapy, relaxation therapy, supportive psychotherapy, and third-wave CBTs) were compared with each other and two control conditions (treatment as usual, waiting list). We followed Cochrane standards when extracting data and assessing data quality and used PRISMA guidelines for the reporting. We conducted random-effects model pairwise and network meta-analyses. We assessed risk of bias of individual studies through the second version of the Cochrane’s Risk of Bias tool and used the Confidence in Network Meta-Analysis (CINeMA) to rate certainty of evidence for meta-analytical results. Severity of GAD symptoms and acceptability of the psychotherapies were our outcomes of interest.ResultsWe analysed data from 66 RCTs. Effect size estimates on data from 5,597 participants suggest third wave cognitive-behavioural therapies (standardized mean differences [SMDs] =-0.78; 95%CI=-1.19 to -0.37; certainty=moderate), cognitive-behavioural therapy (CBT) (SMD=-0.68; 95%CI=-1.05 to -0.32 certainty=moderate), and relaxation therapy (SMD=-0.54; 95%CI=-1.04 to -0.05; certainty=low) reduced generalized anxiety symptoms more than treatment as usual (TAU). Relative risks for all-cause discontinuation signalled no differences compared with TAU for all psychotherapies. When excluding studies at high risk of bias, relaxation therapy lost its superiority over TAU. When considering anxiety severity at three to twelve months after completion of the intervention only CBT remained significantly more efficacious than TAU (SMD=-0.58; 95%CI=-0.93 to -0.23).Image:ConclusionsGiven the evidence for both acute and long-term efficacy, CBT may represent the reasonable first-line psychological treatment for GAD. Third-wave CBT and relaxation therapy have short-term efficacy and may also be offered. Results from this investigation should inform patients, clinicians, and guidelines. This project is funded by the European Union’s HORIZON EUROPE research programme under grant agreement No 101061648.Disclosure of InterestNone Declared

Grading of Recommendations of psychological interventions in the rehabilitation of patients with schizophrenia

IntroductionAs part of the intervention, patients with severe schizophrenia who are cared for in psychiatric rehabilitation units need psychological treatments. However, there is great variability within the psychotherapy alternatives that are proposed for rehabilitation in schizophrenia, and it is necessary to know which are the most efficient interventions in order to prioritize their inclusion in intervention programs.Objectives To know the level of evidence of the existing psychotherapy alternatives for the rehabilitation treatment in schizophrenia through the systematic review of recently published studies.Methods Consecutive systematic searches in the scientific literature were used in a sensitive and specific way, aimed at identifying the existence of documents in databases and clinical practice guidelines based on evidence of psychological treatment in schizophrenia. Psychosocial and social approaches and family members interventions were excluded, and the search was limited to the last 5 years. The PICO format has been used, and a subsequent critical reading using the AGREE II tool, considering the inclusion criteria of presenting a score >60% in 4 domains.ResultsThe following interventions have been found to be therapeutically effective: Level 1B (Early intervention in Psychosis; Patient and Family psychoeducational intervention; Basic ando social skills training; Social cognition and Metakognition training; Cognitive Remediation; Cognitive Behavioral Individual Therapy; Assertive Community treatment; Supported employment). Level 2B (Family Problem Solving Therapy, Dynamic Psychotherapy; Cognitive Behavioral Group Therapy); Level 2C (Horticultural, Art, Music, Animals Therapies).ConclusionsSeveral psychotherapy alternatives are proposed for rehabilitation in schizophrenia, with known level of evidenca in order to prioritize their inclusion in intervention programs.Disclosure of InterestNone Declared

Intensive short-term dynamic psychotherapy for irritable bowel syndrome: a randomized controlled trial examining improvements in emotion regulation, defense mechanisms, quality of life, and IBS symptoms.

Studies have provided evidence for the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in treating medically unexplained symptoms (MUS). This study aimed to examine the effectiveness of ISTDP on individuals living with irritable bowel syndrome (IBS) in terms of, emotion regulation (ER) abilities, defense mechanisms, quality of life (QOL), and IBS symptoms. A total of 30 patients diagnosed with IBS were recruited and randomly assigned to either the intervention (n = 15) or control (n = 15) group. Pre- and post-treatment assessments were conducted, along with a follow-up assessment after ten weeks. Repeated measures analyses of variance were employed to analyze the data. The findings revealed that ISTDP led to significant improvements in ER, defense mechanisms, and QOL, as well as a reduction in the severity and frequency of IBS symptoms. These results provide further support for the efficacy of ISTDP as a treatment modality for individuals with IBS.

Psychotherapeutic approaches and methods and their effectiveness in treating orgasmic dysfunction in women

Orgasmic dysfunction is a sexual disorder in which an orgasm does not occur or is delayed. The prevalence of orgasmic dysfunction ranges from 16% to 28% in Europe, America and mainland China, and from 30% to 46% in other Asian countries. The causes may be physiological, neurological and psychosocial. A literature review was conducted to examine which psychotherapeutic approaches and methods are used in the treatment of orgasmic dysfunction and to examine the results of their effectiveness. All resources linked in this paper have been taken from sources contained in the Scopus or EbscoHost research databases. Throughout this paper we have researched all relevant research papers, removed any duplicates and by applying all the necessary criteria, we have concluded with 15 research articles. The therapeutic approaches and methods with proven efficacy in the treatment of orgasmic dysfunction are: group sex therapy and couples sex therapy, behavioural approaches (Master and Johnson methods, systematic desensitisation), mindfulness-based programmes (Mindfulness-Based Cognitive Therapy - MBCT, Mindfulness-Based Behavioural and Cognitive Therapy), The Betty Dodson Method (a combination of short-term psychodynamic group therapy and self-stimulation methods) and self-help programmes based on video tracking, Cognitive Behavioural Therapy (CBT) and MBCT, and psychosexual therapy manuals. Some self-help programmes also include minimal contact with a therapist. There is an overlap between these approaches (e.g. sex therapy integrates behavioural methods). The results and the review serve as a basis for the application of effective interventions and opportunities for improvement in the treatment of orgasmic dysfunction.

"It takes time to see the whole picture": patients' views on improvement in cognitive behavioral therapy and psychodynamic therapy after three years.

There is a lack of qualitative research that retrospectively explores how patients with major depressive disorder view their improvement in psychotherapy. Fifteen patients who received short-term cognitive behavioral therapy and psychodynamic therapy were individually interviewed approximately three years after completing therapy. Some patients had altered their views on therapy, especially those who initially were uncertain of how helpful therapy had been. They said they did not realize the extent and importance of their improvement in therapy before some time had passed, which can be explained by the surprising cumulative effects of seemingly small changes. This should make retrospective qualitative research an important part of future psychotherapy research.

Psychotherapies at a Glance: Consensus Guideline-Recommended Psychotherapies for Adults With Psychiatric Disorders.

Clinical decision making by psychiatrists and informed consent by patients require knowledge of evidence-based psychotherapies (EBPs) and their indications. However, many mental health professionals are not versed in the empirical literature on EBPs or the consensus guideline recommendations derived from this literature. The authors compared rigorous national consensus guidelines for EBP treatment of DSM-defined adult psychiatric disorders-derived from well-conducted randomized controlled trials and meta-analyses and from expert opinions from the United States, United Kingdom, and Canada-to create the Psychotherapies-at-a-Glance tool. Recommended EBPs are cognitive-behavioral therapy, family therapy, contingency management, dialectical behavior therapy, eye movement desensitization reprocessing, interpersonal psychotherapy, mentalization-based treatment, motivational interviewing, peer support, problem-solving therapy, psychoeducation, short-term psychodynamic psychotherapy, and 12-step facilitation. The Psychotherapies-at-a-Glance tool summarizes the indications, rationales, and therapeutic tasks that characterize these differing psychotherapies and psychosocial treatments. The tool is intended for use in clinical teaching, treatment planning, and patient communications.

Efficacy and executive function of solution-focused brief therapy on adolescent depression.

To investigate the efficacy and impact on executive function of Solution-Focused Brief Therapy (SFBT) in treating Major Depressive Disorder (MDD) in adolescents. A total of 129 adolescents diagnosed with MDD were enrolled in the study. Out of these, 28 adolescents were assigned to the SFBT group, while 25 were part of the Active Control group (AC group), receiving psychodynamic psychotherapy. Executive function, depressive and anxiety symptoms were assessed at baseline, at the time of the third intervention, the sixth intervention, and the 10th intervention. After the third intervention, the scores of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) of the participants in the SFBT group decreased significantly, which had the cumulative effect at the 6th and 10th interventions. The verbal fluency task (VFT) performances of the SFBT group participants yielded significantly higher scores after the third intervention and remained increasing at the 6th and 10th interventions. The AC group steadily decreased after the intervention. Analysis of functional near-infrared spectroscopy (fNIRS) data revealed a progressive and significant increase in the average oxyhemoglobin (oxy-Hb) levels in the dorsolateral prefrontal cortex (DLPFC) in the SFBT group compared to the AC group after the 10th intervention. SFBT might improve depressive and anxiety symptoms as well as executive function of adolescent depression. https://www.chictr.org.cn, identifier ChiCTR2300067909.

Treatment resistance in anxiety disorders-Definition and treatment options

Treatment resistance in anxiety disorders represents aclinical challenge, contributes to the chronicity of the diseases as well as sequential comorbidities, and is associated with asignificant individual and socioeconomic burden. This narrative review presents the operational definition of treatment resistance in anxiety disorders according to international consensus criteria (< 50% reduction in the Hamilton Anxiety Scale, HAM‑A, score or < 50% reduction in the Beck Anxiety Inventory, BAI, score or a clinical global impression-improvement, CGI‑I, score > 2). At least two unsuccessful guideline-based treatment attempts with pharmacological monotherapy or at least one unsuccessful treatment attempt with adequately delivered cognitive behavioral therapy are required. Pharmacotherapeutically, after excluding pseudo-resistance, switching the medication within one class or to another class and augmentation strategies with other antidepressants (mirtazapine, agomelatine), antipsychotics (quetiapine) or anticonvulsants (valproate) are recommended. Psychotherapeutically, third-wave therapies, psychodynamic therapy, systemic therapy and physical exercise can be considered for therapy resistance. In cases of no response to psychotherapy or pharmacotherapy, the respective other form of therapy or acombination of both should be offered. Compounds targeting the glutamatergic and endocannabinoid systems as well as neuropeptides are being tested as potential innovative pharmaceuticals for treatment-resistant anxiety disorders. There is an urgent need for further research to identify predictive markers and mechanisms as well as to develop innovative pharmacological and psychotherapeutic interventions for treatment-resistant anxiety disorders.

(081) Enhancing Treatment for Patients with Medically Unresolved Persistent Sexual Dysfunction: What can be Learnt from Mixed Methodology Evaluation-Research?

Abstract Introduction Introduction: In adult healthcare delivery worldwide, medically unresolved persistent physical symptoms (uPPS) are of significant concern (Bermingham et al., 2010; Sumathipala, 2007), with patients often requiring an enhanced therapeutic approach (Nimnuan et al., 2001; Dwamena, et al., 2009). When routine medical care is not achieving desired patient outcomes for Unresolved Persistent Sexual Symptoms (uPSS) (erectile dysfunction (ED), rapid ejaculation (RE), genital pain and diminished sexual desire), the evidence for the best practice is limited. More research is needed in this area and whilst RCTs remain the gold standard in evidence-based medicine, there are limitations. At present there is no international consensus on the use of mixed method research parameters in studies involving patients with uPPS. Sexual Medicine teams are ideally placed to develop an enhanced approach to their own uPSS sufferers. We share our experience of an evaluation-research process and report its use, adaptations, and important findings. Objective Objectives: To present our experience of Realist Evaluation methodology in developing a cross-modality consultation model: Engaging the adult patient with uPSS. Methods Methods: Following NHS ethical approval using RAMESES standards (Wong et al., 2013), we conducted mixed method data comparisons by 3 stages: 1. A wide scoping of the literature, 1990–2014, 2. A Realist Literature Synthesis (2001–2014) of efficacy or effectiveness of Short-term Psychodynamic Psychotherapy (STPP), compared through common themes of engagement with Cognitive Behavioural Therapy (CBT) for uPPS. 3. Demographics, referral sources, length of history and clinical intervention outcomes were extracted from an established NHS psychosexual service. The comparative literature findings were used to develop a common-factor thematic analysis of 24 full transcripts from four adult prospective consecutive cases. Validated measures of wellbeing and symptoms severity with goal attainment measures supported further. Results Main Results: A synthesis of the literature from stages 1. and 2., supported by clinical experience, led to a succinct definition for the majority of adult uPPS sufferers within which the uPSS cohort is embraced. A Realist equation, ‘Context plus Mechanism = Outcomes’, developed across the case data showed the simple means of discovering the unique precipitating, predisposing, and perpetuating factors of the individual’s uPSS (an approach potentially transferrable to other uPPS). Further, the extraction of common factors perpetuating the uPSS over time plus an accessible set of collaborative principles of engagement for disabling these, substantiated the consultation model. Of the measures, personal goal attainment improvements over time in therapy were the most aligned to the transcript analyses showing improved subjective outcomes and personal satisfaction. Conclusions Conclusions: The literature synthesis revealed the paucity of high-quality mixed method research into uPPS talking therapy interventions and none for heterogenous uPSS. This was the first use of an enhanced evaluation-research methodology in this context. Due to the data emerging from the embedded cases it was possible to construct the foundational cross-modality consultation model. At the time of the study, the lack of available clinical service comparator limits the generalisation of our findings to uPPS. Our experience shows from the systematically developed outcome data that realist evaluation can be used appropriately, requiring further research. Disclosure No.

Repairing alliance ruptures in psychodynamic psychotherapy with young people: The development of a rational-empirical model to support youth therapists.

Alliance ruptures in youth psychotherapy can have a significant impact on treatment outcomes. However, there is currently limited guidance on how to effectively repair these ruptures with young people. This study aims to address this gap specifically in the context of psychodynamic psychotherapy with adolescents. The objectives of the study are (a) to understand the therapeutic interventions and attitudes that either facilitate or hinder the resolution of alliance ruptures and (b) to develop a model for repairing these ruptures within this particular treatment approach. To accomplish this, a task analysis of a previously developed rational model of resolving alliance ruptures was conducted using 16 sessions from short-term psychodynamic psychotherapy with depressed adolescents. The analysis supported some stages of the hypothesized rational model while revealing the need for revisions. As a result, the study developed a rational-empirical model that includes flexible strategies that therapists can use to repair alliance ruptures. This model emphasizes the significance of a collaborative, open, and empathetic approach to resolving ruptures. In contrast, rigid, defensive, or invalidating therapist attitudes can hinder the resolution process. The evidence-based model developed from the study can provide valuable guidance to psychodynamic psychotherapists working with young people, offering insights on how to approach ruptures and employ effective strategies to promote their resolution. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Aggression in Psychodynamic Psychotherapy and Supervision: Becoming a More Effective Therapist.

Access to one's healthy aggression is critical for both patient and therapist. On the patient's end, the ability to access and modulate aggression is fundamental to the establishment of healthy self-esteem and the capacity to sustain relationships and pursue life goals. On the therapist's end, access to aggression allows for the setting of a secure therapeutic frame and the subsequent conduct of the deep work of therapy. Conversely, lack of access to aggression creates burdensome and problematic situations that may subvert the treatment. Beginning therapists have a particular susceptibility to minimize their own aggression given certain factors in their choice of profession. Supervisors' modeling of the experience of aggression, as well as the provision of a safe atmosphere in which new clinicians become comfortably aware of their own and their patients' aggression, will help fortify beginning therapists' capacity to harness their aggression in the service of the work.

Validation of the German version of the Comparative Psychotherapy Process Scale.

The Comparative Psychotherapy Process Scale (CPPS) is a 20-item scale which aims to capture technical features distinguishing cognitive behavioral (CBT) from psychodynamic (PD) psychotherapy (and vice versa) in two corresponding subscales (CBT and PD Subscale). Our objective was to validate a German self-report version of the CPPS regarding a previous psychotherapy session in a psychotherapist- and in a patient-version. Fifty-three psychotherapists and their 53 patients answered to the according German CPPS Scale as well as to specific subscales of the Multitheoretical List of Therapeutic Interventions self-report-instrument (MULTI-30 subscales) assessing CBT- and PD-specific intervention characteristics. We analyzed (a) the correlation of the CPPS with the MULTI-30 subscales, (b) the ability of the CPPS to distinguish whether therapy sessions were either CBT or PD using logistic regression, and (c) the correlation between psychotherapists' and patients' self-report regarding the preceding session (correlation). Both the psychotherapist- and the patient-version showed acceptable to good values of internal consistencies (α = .78-.84). The CBT and PD Subscales of the MULTI-30 correlated with the CPPS subscales in both versions (CBT: rs = .85 [psychotherapist-version] and .80 [patient-version], PD: rs = .79 [both versions]). Subscales correctly discriminated whether the previous session was a CBT or a PD session (correct predictions in 88.7% in the psychotherapist-version, 73.6% in the patient-version; χ² ≥ 14.03, p < .001). The German version of the CPPS is a promising instrument to facilitate research on CBT- and PD-specific psychotherapy processes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Character Change in Less Frequent Therapies: Psychodynamic and Transference Implications.

An approach to a once-weekly, or bimonthly (every second week), ongoing psychodynamic psychotherapy is described. The detailed description of individual sessions is intended to show the process of the uncovering of unconscious phenomena using this approach, though the therapies described are not complete. Important changes that have already occurred are described. The approach is characterized by a direct method of discovery of early painful situations that underlie specific problematic experiences in the present. The therapeutic stance is designed to establish a collaborative relationship with the patient that becomes the substrate of the relationship and often leads to an identification with the therapist who becomes an ongoing presence in the patient's life.

Identifying who benefits most from supportive versus expressive techniques in psychotherapy for depression: Moderators of within- versus between-individual effects.

A recent randomized controlled trial (RCT) indicated that individuals with higher levels of attachment anxiety exhibited better treatment outcomes in supportive-expressive therapy (SET) relative to supportive therapy (ST). But to gain insight into within-patient therapeutic changes, a within-individual design is required. The present study contrasts previous findings based on theory-driven between-patient moderators with data-driven moderators of within-patient processes to investigate whether findings converge or diverge across these two approaches. We used data of 118 patients from the pilot and active phases of a recent RCT for patients with major depressive disorder, comparing ST with SET, a time-limited psychodynamic therapy. The predefined primary outcome measure was the Hamilton Rating Scale for Depression. Supportive versus expressive techniques were rated based on patients' end-of-session perspective. We compared previous findings based on moderators of between-patient effects with a data-driven approach for identifying moderators of within-patient effects of techniques on subsequent outcome. After false discovery rate corrections, of 10 preselected moderators, patients' attachment anxiety and domineering style remained significant. Of these, bootstrap resampling revealed significant differences between ST and SET techniques for the attachment anxiety moderator: Those with higher attachment anxiety benefited more from greater use of ST than SET techniques in a particular session, as evidenced by lower levels of symptoms at the subsequent session. Our within-individual findings diverge from previously published between-individual analyses. This proof-of-concept study demonstrates the importance of complementing between-individuals with within-individual analyses to achieve better understanding of who benefits most from specific treatment techniques. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Actual problems of eating disorders and ways to solve them

As eating disorders become more and more common, it is necessary to understand the influence of modern life factors on the formation of these diseases in order to develop more effective strategies for their prevention and treatment, so the purpose of this study was to systematically examine the sociocultural and psychological factors of eating disorders. Two key methodological approaches were used to study the social and underlying psychological factors of these disorders: sociocultural and psychoanalytic. The empirical basis of the study is based on the interview method. Social factors, in particular media influence, determine the formation of eating disorders, especially among women, through the creation of negative standards of beauty and bodily satisfaction. Based on interviews with people with eating disorders, it was found that the underlying psychological factors of these disorders are mainly focused on intrapersonal aspects, such as the perception of food and one's own body, emotional sphere, and self-esteem. At the same time, interpersonal factors related to interaction with the environment have a lesser impact. These factors can lead to the development and complicate the course of eating disorders, so it is important to work with psychological aspects for effective treatment. It is substantiated that psychodynamic and Gestalt therapy are effective treatment methods aimed at resolving mental conflicts. Both approaches use a variety of methods, including dream analysis and physiotherapy, to help patients understand and resolve their emotional and behavioural interactions with food. The practical value of the study is that its results highlight the need to use psychodynamic and Gestalt approaches in therapy, which can address the underlying psychological and emotional factors of eating disorders. The study can be applied in the activities of institutions specializing in the treatment of eating disorders

A practice-based study of relational virtues and alliance correspondence in psychodynamic psychotherapy.

Treatment outcome monitoring typically emphasizes pathology. In contrast, we responded to the need to establish psychodynamic psychotherapy as evidence-based by modeling changes in gratitude and forgiveness. We utilized a practice-based research design involving non-manualized outpatient treatment. We employed a longitudinal mixture modeling approach to evaluate treatment effectiveness. We did so by testing the theorized role for relational virtues (i.e., gratitude, forgiveness) as signs of progress in psychodynamic treatment, with relational virtues referring to the application of character strengths to specific situations. We modeled clients' self-reported level on the virtues as a joint process over five time points, and examined the influence of early treatment alliance correspondence on patterns of change using a sample of outpatient clients (N = 185; Mage = 40.12; 60% female; 74.1% White). A 3-class solution best fit the data, with one class exhibiting growth in gratitude and forgiveness, improved symptoms, and a greater likelihood of symptom improvement relative to well-being gains. Alliance correspondence predicted the classes of change patterns, with greater similarity between clinicians' and clients' perceptions about the alliance predicting greater likelihood of belonging to the subgroup showing highest levels of virtues and well-being, lowest symptoms, and improved well-being. Clinical implications involve monitoring gratitude and forgiveness as signs of progress and navigating the dialectic between implicit alliance processes and explicit virtue interventions. The former involves nurturing a strong alliance and repairing ruptures, whereas the latter involves direct in-session conversation and/or the practice of virtue interventions in and/or outside of session.